Bogleheads: What are you doing to prepare for dementia/alzheimers?

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CULater
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Bogleheads: What are you doing to prepare for dementia/alzheimers?

Post by CULater » Fri Feb 23, 2018 1:46 pm

As a 7th-decade senior who is single, I've been doing a lot of thinking these days about growing older and preparing for the time when I won't be able to care for myself. I was mostly thinking about physical infirmity, but the real concern is actually mental infirmity -- which is something that most of us don't think about at all or don't think could happen to us. Not sure what percentage of people in their 70s and 80s develop some form of dementia/alzheimer's but I bet it's pretty staggering, and the really bad part is that care for these illnesses is hugely expensive and you can last a long time. Not to mention that you won't have the cognitive capacity to manage your own care or your own finances.

What brought this home to me shockingly was the recent diagnosis of Dementia with Lewy Bodies received by a friend of mine, who is in his 60s. Six months ago, he was teaching classes and leading his normal life. Now he can't use a credit card, drive a car, watch a movie, read a book or newspaper, walks with a shuffling gait hunched over like a man in his 80s. Lewy Bodies is the ailment that afflicted Robin Williams.

I just learned that when my friend was diagnosed, he was told that one of the most significant precursors of Lewy Bodies is disrupted REM sleep, in which one acts out dreams. This can begin showing up many years prior, and it turns out my friend had noticed this about 5 years ago and has a hole his bedroom wall where he kicked it out during a dream. Learning this has gotten my attention big-time, because it turns out that this has happened to me recently and I'd never done that before. In one instance, while having a dream I managed to kick a large, heavy suitcase off the other side of a king bed and all the contents were strewn all over the floor. There have been some other instances of acting out dreams as well. Of course, that doesn't mean I am developing Lewy Bodies. But it does mean that maybe I ought to wake up and smell the coffee; in fact it's probably likely that I'll develop some form of dementia, maybe sooner than I think; e.g., my friend was "normal" just six months ago.

So, after this long preamble, I've decided it's past time to stop putting off this topic and taking personal steps to prepare for it's eventuality. Pascal's Wager: I'd rather be prepared and be wrong than the other way around. So, I'd be interested in starting a conversation and sharing the thoughts and suggestions of others who have thought about this, or who are going through or have gone through this with someone else. What should be done to prepare financially? for management of my care? where am I going to have to live and how can I arrange to pay for it if I'm not really capable of handling these issues at that time? Who will look out for my welfare? What else should I be thinking about?
May you have the hindsight to know where you've been, The foresight to know where you're going, And the insight to know when you've gone too far. ~ Irish Blessing

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Re: Bogleheads: What are you doing to prepare for dementia/alzheimers?

Post by Christine_NM » Fri Feb 23, 2018 2:02 pm

Medical topics are off limits here, with good reason.

All you can do is make a will and designate power of attorney for healthcare, and another for finances. Then enjoy independence while you have it.

If you have no hope of affording a "nice" memory unit (for dementia patients) then I suppose you will want to qualify for Medicaid.
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Re: Bogleheads: What are you doing to prepare for dementia/alzheimers?

Post by afan » Fri Feb 23, 2018 2:05 pm

Forum rules prohibit offering medical advice beyond "see your doctor if you are concerned about your health"

For financial concerns:
Make sure you have a durable power of attorney (DPOA) with someone trusted and responsible as the attorney in fact. This will, in principle, give that person the right to act on your behalf to manage your finances if that becomes necessary.

I say "in principle" because many financial institutions refuse to honor DPOAs. They insist that you fill out their own POA documents specific to their accounts. So do that as well. You still will want the DPOA since it attempts to cover anything for which you did not get a firm-specific POA filed.

Make sure you have someone who has your health care proxy, who can make medical decisions on your behalf.

Designate the person who has your other powers of attorney with the POA for any retirement accounts you have.

If you have taxable investments, a home, or other property outside of retirement accounts, have your attorney create a revocable trust, transfer these assets into the trust, and appoint the same person you has your POAs as cotrustee of the trust. You could have them as successor trustee, but then they will have to prove that whatever event is supposed to trigger their succession has occurred.

For concerns about daily living, consider moving into a continuing care retirement community. These places offer condominium style living while you are independent but are prepared to move you into assisted living all the way up to full nursing home as your needs indicate. They are not cheap, but since you live there, you would not need to keep a separate home elsewhere.
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Re: Bogleheads: What are you doing to prepare for dementia/alzheimers?

Post by j0nnyg1984 » Fri Feb 23, 2018 2:10 pm

My dad has this, so unfortunately, I know it well. Luckily my mom and dad saved well; they have over 1mm in the bank and investments. Damn good thing, too, because his mental care home is eating up 9k a month...

I'm not doing anything special. I mean, how can you prepare to be in a head-on car crash? Just gotta save, live well, and have your documents in order for the future.

Seriously, besides these, I plan on killing myself in South America, or maybe SE Asia, when the time comes. I'll enjoy spending my retirement money, and when it's gone, I'll make sure I disappear too. There's no way I want to live how my dad currently is.

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Re: Bogleheads: What are you doing to prepare for dementia/alzheimers?

Post by CULater » Fri Feb 23, 2018 2:28 pm

Thanks. Not seeking medical advice. Am really focused on financial and care planning that is relevant to preparing for the possibility of developing dementia/alzheimer's. I believe it is an under-anticipated issue for many of us.
May you have the hindsight to know where you've been, The foresight to know where you're going, And the insight to know when you've gone too far. ~ Irish Blessing

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Re: Bogleheads: What are you doing to prepare for dementia/alzheimers?

Post by WhiteMaxima » Fri Feb 23, 2018 2:30 pm

Enjoy your hard earned money now.

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Re: Bogleheads: What are you doing to prepare for dementia/alzheimers?

Post by dm200 » Fri Feb 23, 2018 2:36 pm

1. Have documents (POA, medical authorizations, etc. up to date).

2. Move to simplifying assets, etc.

3. One potential risk is being taken advantage of. Not sure how to deal with? Maybe relative/friend help?

4. We cannot go into ANY details here, but I am 100% convinced lifestyle changes can reduce or shorten the risk. I have and am making such changes. Side effects of prescription drugs (or not taking correctly) can induce such problems - good news because this can be corrected.

Several grandparents went through such difficulties (several different aspects)

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Re: Bogleheads: What are you doing to prepare for dementia/alzheimers?

Post by delamer » Fri Feb 23, 2018 3:07 pm

You may be young enough to qualify for long-term care insurance. It is expensive and not a complete answer, but it is a safety net.

My mother had dementia the last year or so of her life. She had lived in a Continuing Care Retirement Community in an independent apartment for 14 years, and then moved into the nursing home on the same campus.

The CCRCs are not cheap. My parents had to put down a significant non-refundable deposit and the monthly fee by the time my mother died was over $4,000/month. But the advantage was that her monthly fee did not increase when she moved into the nursing facility. If she was paying the nursing care “off the street” it would have been $12,000/month (yes, twelve thousand). Plus she got moved to the top of the waiting list in the home and would have in the assisted living apartments, if eligible.

I would not recommend moving into a CCRC before your mid-70s, just because the average age skews so high. On the other hand, you can’t wait until you have physical or mental health issues because you may be rejected for admission. (This just happened to a friend of my in-laws who was diagnosed with mild dementia during her admission’s physical.)

I am sorry about your friend. My mother’s dementia did not develop until she was in her early 90’s which is so much different than for someone in his 60’s. Unfortunately, my mother’s siblings and my grandmother also all had dementia. Therefore, a CCRC is something I expect will be in my future.

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Re: Bogleheads: What are you doing to prepare for dementia/alzheimers?

Post by Peter Foley » Fri Feb 23, 2018 3:42 pm

I am fortunate enough to have a wife (five years younger) and two responsible adult children. We have had family meetings so that both our children have a working knowledge of our finances.

Will, Power-of Attorney, and Advanced Directive are a must.

I have mentioned in other threads that I think it is prudent not to convert all of one's tax deferred into Roths. There may come a time in our lives where some sort of assisted living is needed. The high cost of these arrangements would likely result in one or more low tax years. So paying for this from a pre-tax account might represent a significant savings when compared to paying from converted Roth funds.

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Re: Bogleheads: What are you doing to prepare for dementia/alzheimers?

Post by Gnirk » Fri Feb 23, 2018 4:47 pm

As others have already advised: Durable Power of Attorney for financial, with an alternate named as well. The same for Medical Power of Attorney. An advanced care directive, stating your wishes about your care decisions. In addition, if this is truly a concern, I would write down how you want to be cared for, and even where, if possible. Investigate what care options are available in your area. Small private care home that specializes in memory issues, a large Memory Care Facility, etc.

My mother suffered from dementia for 12 years, 8 of those years being cared for in a private care home. I managed her care and her finances during that time. It is not an easy job, so be sure the people you choose to take on this task are up to it. I knew how my mom wanted to be cared for, and I knew how she invested, so I carried those things out as she wished, heartbreaking as it was.

For myself, I maintain enough of my investments in bonds to cover at least 6-9 years of care, at about $70K-$100K per year.

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Re: Bogleheads: What are you doing to prepare for dementia/alzheimers?

Post by dcabler » Fri Feb 23, 2018 5:00 pm

When we were around 50, my wife and I both purchased LTC insurance. More for her, less for me.

Why?
- Me: big family and zero history including many relatives who lived into their 90's
- DW: Mom, Mom's twin sister, Mom's brother, Mom's aunt all had Alzheimer's. DW's Dad did have LTC insurance for years for both of them, but cancelled it just a few years before Mom was diagnosed.

Beyond that, what others have said regarding durable POA, etc.

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Re: Bogleheads: What are you doing to prepare for dementia/alzheimers?

Post by dodecahedron » Fri Feb 23, 2018 5:08 pm

There is a book that addresses the OP's specific concerns: What to do when I get stupid: A radically safe approach to a difficult financial era.

A beloved relative had dementia with Lewy bodies. Other relatives have sudden unexpected strokes or heart attacks. Their experiences motivated me to get the book a while ago, but those issues seemed "far away."

Thanks to the OP for reminding me that I probably should re-read the book periodically as I get older.

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Re: Bogleheads: What are you doing to prepare for dementia/alzheimers?

Post by earlyout » Fri Feb 23, 2018 5:11 pm

Besides the POA for healthcare you might want to discuss and document how you would like to be taken care of as your dementia progresses. Guides for such end-of-life discussions are available -- "The Conversation Project" (use Google) and www.dementia-directive.org. I am not affiliated with either but these guides are a good starting point for creating an enhanced advance directive for yourself or for a family member that may be living with dementia.

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Re: Bogleheads: What are you doing to prepare for dementia/alzheimers?

Post by four7s » Fri Feb 23, 2018 5:27 pm

Guardianship rules vary from state to state and it is critical to know how your state treats its citizens. Never trust the goodwill of lawyers, judges, senior prrotective beaurcrats, etc. It is a nightmare when unscrupulous officials take over your life. Step #1 is to learn about this and then to find the right lawyer to set things up. I've wittnessed the most dastardly officials with the support of the law taking over one's life with no recourse, Learn where you stand and pay the atty. to protect you as much as possible.

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Re: Bogleheads: What are you doing to prepare for dementia/alzheimers?

Post by visualguy » Fri Feb 23, 2018 5:30 pm

If you are single and have no kids, things get more difficult. Not sure what's available out there as a solution for managing your finances and your care. There's a big concern about fraud and abuse as mentioned above. Maybe there are siblings, or nieces/nephews, or really close friends. If none of that, I'm really not sure what one is supposed to do... Maybe a trust company? Attorney offices that do this?

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Re: Bogleheads: What are you doing to prepare for dementia/alzheimers?

Post by carruthers209 » Fri Feb 23, 2018 5:31 pm

Let's hope for the best and your acting out dream wasn't a precursor for something worse. If I were you I would be making an appointment to see a neurologist. Their specialty includes issues that you are concerned with and by the way, acting out your dreams (ii.e. REM disturbances) can also be Parkinson's-usually a much slower progression and there are medications and therapies that can be very helpful. Alzheimer's is often diagnosed via a test called the Mini-Mental which has a numeric score and checks for cognitive impairment. It's possible you are fine-but it's a good idea to be proactive and have your legal and financial plans in order.

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Re: Bogleheads: What are you doing to prepare for dementia/alzheimers?

Post by Dinosaur Dad » Fri Feb 23, 2018 5:41 pm

Gnirk wrote:
Fri Feb 23, 2018 4:47 pm
As others have already advised: Durable Power of Attorney for financial, with an alternate named as well. The same for Medical Power of Attorney. An advanced care directive, stating your wishes about your care decisions. In addition, if this is truly a concern, I would write down how you want to be cared for, and even where, if possible. Investigate what care options are available in your area. Small private care home that specializes in memory issues, a large Memory Care Facility, etc.

My mother suffered from dementia for 12 years, 8 of those years being cared for in a private care home. I managed her care and her finances during that time. It is not an easy job, so be sure the people you choose to take on this task are up to it. I knew how my mom wanted to be cared for, and I knew how she invested, so I carried those things out as she wished, heartbreaking as it was.

For myself, I maintain enough of my investments in bonds to cover at least 6-9 years of care, at about $70K-$100K per year.
+1 this post pretty well mirrors my experience. We started with care a few hours a day, progressed to 24/7 in home, then finally nursing home. You have to think about the total cost: medical, daily assistance/transportation, do you have an "adult day" program (Mom had this and it was really good for her), and then ultimately you might have to figure out nursing home care/billing and Medicaid if you're eligible. the documents like Durable Power of Attorney are crucial, and you also have to be willing and able to step in and manage things financially or hire someone who can. My Mom had dementia also; we ended up paying one of my siblings to be primary overseer of the caregivers we hired, as well as mom's "wingman" for doctor visits, to ensure she got good care. How much you set aside is really up to you...there are lots of threads and ideas about how to best do that...must consider total value of assets, Medicaid eligibility, etc.
"Take calculated risks - that is quite different from being rash." | General George S. Patton

CULater
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Re: Bogleheads: What are you doing to prepare for dementia/alzheimers?

Post by CULater » Fri Feb 23, 2018 5:50 pm

Peter Foley wrote:
Fri Feb 23, 2018 3:42 pm
I am fortunate enough to have a wife (five years younger) and two responsible adult children. We have had family meetings so that both our children have a working knowledge of our finances.

Will, Power-of Attorney, and Advanced Directive are a must.

I have mentioned in other threads that I think it is prudent not to convert all of one's tax deferred into Roths. There may come a time in our lives where some sort of assisted living is needed. The high cost of these arrangements would likely result in one or more low tax years. So paying for this from a pre-tax account might represent a significant savings when compared to paying from converted Roth funds.
That is an interesting idea about converting to Roth that I hadn't thought of. You are certainly correct that high medical deductions can reduce your taxes, and you might end up paying fewer taxes out of a tIRA than the tax you would pay to convert to a Roth. This assumes that the medical deduction will remain in place. In the proposed 2018 changes, there was a possibility it would be eliminated, so that's something to keep and eye on. This is the sort of thing that someone would have to take care of for you if your cognitive abilities declined. It would seem to make some sense to keep a notebook and write some of this stuff down to inform those who might be caring for you what your plans were for your finances. How many of us do that?
May you have the hindsight to know where you've been, The foresight to know where you're going, And the insight to know when you've gone too far. ~ Irish Blessing

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Re: Bogleheads: What are you doing to prepare for dementia/alzheimers?

Post by staythecourse » Fri Feb 23, 2018 5:56 pm

Honestly, the biggest thing I would identify is WHO is going to help you if the inevitable happens. It is NOT getting dementia that is the worst, but when you don't have anyone in your life to help you. Usually, it is spouse and/ or children, but if you don't have any it makes it a bit more difficult. Friends are not that useful especially if they are the same ages as you as they will have their OWN health issues to deal with. Is there anyone in your life you can identify as someone who will be willing to help you get your affairs in order? Everyone just assumes POA to sign stuff, but who is going to sell your house, pay your bills, choose a living facility, etc...

Good luck.
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Re: Bogleheads: What are you doing to prepare for dementia/alzheimers?

Post by montanagirl » Fri Feb 23, 2018 6:15 pm

Right now, I worry about more mundane, precursory issues: how to make sure bills get paid as one begins to "lose it"? Monthly bills and property tax keep increasing. Would you authorize the payee to "pull" the right amount from the bank, so all household expenses are on automatic pilot?

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Re: Bogleheads: What are you doing to prepare for dementia/alzheimers?

Post by mac808 » Fri Feb 23, 2018 6:26 pm

Adult adoption? Only half joking. Got any good friends in reasonable health, a generation or so younger than you?

I'm surprised more young attorneys don't pursue this as an opportunity - charge $5k annually to help oversee the affairs of elderly upper middle folks who are all alone. Or maybe they do and I haven't encountered it. Or maybe they don't because it turns into a nightmare and isn't worth the money.

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Re: Bogleheads: What are you doing to prepare for dementia/alzheimers?

Post by DrGoogle2017 » Fri Feb 23, 2018 6:30 pm

I have two kids, one said she will take care of the money part, the other one is going to take care of the rest. By the time I’m in my 90s, my first child will be in her 60s. She is in her retirement anyway. I just need them to hire people in my home and take care of me.
I do know of a relative who has both dementia and Parkinson’s but not Lewd bodies, he was successfully taken care off at home. He passed away after maybe 5 years of first diagnosis.

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Re: Bogleheads: What are you doing to prepare for dementia/alzheimers?

Post by Shallowpockets » Fri Feb 23, 2018 6:37 pm

This is difficult for anyone who is single, for whatever reason, and goes forward into old age.
What to do when you cannot care for yourself and don't even know it. No awareness of your situation. Not sure if that would be a good thing or a bad thing. No one knows what an alzheimers patient thinks.
Maybe you could visit an Alzheimer's home and see what the people there say. Not the residents, but the staff. Maybe talk to the admissions and evaluation people about criteria and costs.
I often wonder when a person gets to that point what are they thinking, if at all. Does anything matter? Usually it is the family members who are concerned. But, if no family members, what might be the problem? Once you cannot care for yourself and don't even know it, is it really a problem for you?
Surely one must act well before the time. Your faculties may diminish and you could be unaware they are on the decline.

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Re: Bogleheads: What are you doing to prepare for dementia/alzheimers?

Post by dodecahedron » Fri Feb 23, 2018 6:42 pm

Shallowpockets wrote:
Fri Feb 23, 2018 6:37 pm
Once you cannot care for yourself and don't even know it, is it really a problem for you?
Surely one must act well before the time. Your faculties may diminish and you could be unaware they are on the decline.
My understanding is that many folks have fluctuating cognitive facilities, especially during the transition times.

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Re: Bogleheads: What are you doing to prepare for dementia/alzheimers?

Post by Skiffy » Fri Feb 23, 2018 6:50 pm

The trouble with developing dementia is you may not be self aware of decline and inability to make good decisions. MIL had to be removed (unwillingly) from her home, she forgot to eat, drink, bills unpaid etc. She still thinks she could live by herself, was diagnosed with dementia about a year ago. She is not aware of her own decline or her rapidly deteriorating memory.

What can you do if you don’t have someone who is willing to intervene, even against your will !

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Re: Bogleheads: What are you doing to prepare for dementia/alzheimers?

Post by Artsdoctor » Fri Feb 23, 2018 7:27 pm

CULater wrote:
Fri Feb 23, 2018 2:28 pm
Thanks. Not seeking medical advice. Am really focused on financial and care planning that is relevant to preparing for the possibility of developing dementia/alzheimer's. I believe it is an under-anticipated issue for many of us.
I don't think this topic is against the rules at all. Basically, you're talking about how to protect your assets against cognitive decline of any sort.

This has been described in the Wall Street Journal on many occasions, and it's discussed in several retirement planning books. While everyone is unique, you need to be aware of the statistics.

Your ability to make complex financial decisions wanes as you age. To think otherwise is just magical thinking. The steps you can take that would help depend on your social set-up to some extent.

You're going to want to include someone to look over your shoulder. It can be a trusted family member, a friend, or at some point, an entity like Vanguard (they will definitely manage your finances for a small fee).

You're going to want to simplify your finances. If you have 10 CDs at 10 separate banks, stop it. If you have multiple accounts at Schwab, Fidelity, Vanguard, and TD Ameritrade, consolidate.

You need to have your passwords available for the people who you'd want looking after your finances if you can't.

Whoever you name as your financial POA, you need to sit down and chat with him/her. I can't tell you the number of times I've found out that I've been named a POA and the person hasn't even discussed it with me.

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Re: Bogleheads: What are you doing to prepare for dementia/alzheimers?

Post by benway » Fri Feb 23, 2018 8:17 pm

j0nnyg1984 wrote:
Fri Feb 23, 2018 2:10 pm
My dad has this, so unfortunately, I know it well. Luckily my mom and dad saved well; they have over 1mm in the bank and investments. Damn good thing, too, because his mental care home is eating up 9k a month...

I'm not doing anything special. I mean, how can you prepare to be in a head-on car crash? Just gotta save, live well, and have your documents in order for the future.

Seriously, besides these, I plan on killing myself in South America, or maybe SE Asia, when the time comes. I'll enjoy spending my retirement money, and when it's gone, I'll make sure I disappear too. There's no way I want to live how my dad currently is.
I’m not sure if this was said tounge-in-cheek. I have similar experiences and I do not want this to happen to me or to my family.
Last edited by benway on Fri Feb 23, 2018 8:22 pm, edited 3 times in total.

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Re: Bogleheads: What are you doing to prepare for dementia/alzheimers?

Post by littlebird » Fri Feb 23, 2018 8:19 pm

As the spouse of someone with Parkinson's Disease, though, not dementia, who has handled our -- and his -- affairs for years, I endorse afan's post, above. I would emphasize that a revocable trust is imperative in your situation, because it commands much more deference than a POA, especially when the holder of the POA (properly called an attorney-in-fact) is not a spouse. It's also a much more powerful and versatile document that can accomplish many other things for you.

As others have stated, your main problem is deciding who can appropriately manage the roles of attorney-in-fact and co-trustee -- and eventually sole-trustee -- for you. If you have nobody you can entrust with this job, your only option, as far as I know, is an institutional trustee, that is a bank or other financial firm that does this work. I would not recommend Vanguard, because of their physical and institutional remoteness and lack of flexibility. If it were me I would consider a good regional bank and possibly Schwab (caveat: I've never looked into the latter as a possible trustee).

I would bring them on as co-trustee well before absolutely necessary, although it costs. In my opinion your peace of mind will make it worthwhile. They will be far more effective if they have worked with you and settled all details before a crisis occurs. I also keep my financial life as simple as possible - auto pay or phone pay c.c. bills and utility bills, auto deposit all income streams. I no longer open accounts for bonuses.

If you use a family member as trustee, you must have a way to make them aware of the on-going details of your financial and personal life. For myself, and for my spouse if I predecease him or become disabled, I keep my daughter apprised of the major events in my life. The details -- where, how, when, -- are in a pair of loose-leaf binders; one in my desk and one in her's across the country. I keep them up-dated by hand, mailing her copies of changes. Having been through at least 10 computers since 1982 or so, I don't feel comfortable relying on my home computer, but younger people certainly will. The important thing is to figure out how another person will accomplish the tasks they would need to do for you in various scenarios, and then document it for them.

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Re: Bogleheads: What are you doing to prepare for dementia/alzheimers?

Post by Boglescientist » Fri Feb 23, 2018 8:39 pm

Long time lurker .First post. I learned a lot about finance from this forum, so thought it would be worthwhile to give my 2 cents on this.

Alzheimers and many neurological disorders have no drugs or therapy in market and no sign of real progress. Pfizer just shut down its Alzheimers R&D because it seems to be a graveyard for drug discovery and many pharma companies will follow suit.
As much as savings and finance planning is important, you should also focus on lifestyle changes that might help preventing these disorders.

1. Eat healthy with plenty of veggies and nuts in your diet. These natural powerfoods are rich in anti ageing nutrients that will provide strength Avoid processed food, refined sugars.

2. Walk and breathe fresh air atleast 30 min everyday. As you age, strength of your legs is important as that allows you to be independent and less reliant on others.Besides, falling down from stairs and in bathroom is common among elders that leads to unwanted head injuries.

3. Keep your brain active. Constantly read and force yourself to learn new information. While you might retire from a job, your brain should never retire 8-) . Recording and recalling daily events at the end of the day in a journal might help.

4. Avoid depression. As u age you might develop depression. Try to be positive and meet new people or make new friends. Learn new hobbies if it allows u to meet new people.The more people you are in touch with the higher the chances you will be content and less depressed.

P.S. Also watching less cable news and thinking the world is going to end any day now also helps :wink:

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Re: Bogleheads: What are you doing to prepare for dementia/alzheimers?

Post by LadyGeek » Fri Feb 23, 2018 9:00 pm

Boglescientist, Welcome!

Let's keep this discussion focused on the financial aspects.
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SGM
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Re: Bogleheads: What are you doing to prepare for dementia/alzheimers?

Post by SGM » Fri Feb 23, 2018 9:25 pm

I am considering adding some single premium immediate annuities later in life. I also am delaying SS to 70. The idea is to have some income that will come in regardless of my ability to manage a portfolio. I am working on teaching my grown children how to run their own and family finances. Part of the plan is to have the children temporarily use a Vanguard advisor. I would consider turning over my portfolio to the Vanguard advisor program. The children currently have a voice in how to manage our family accounts. Beneficiaries have been set up for taxable accounts and Roth accounts.

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Re: Bogleheads: What are you doing to prepare for dementia/alzheimers?

Post by radiowave » Fri Feb 23, 2018 9:29 pm

Artsdoctor wrote:
Fri Feb 23, 2018 7:27 pm

I don't think this topic is against the rules at all. Basically, you're talking about how to protect your assets against cognitive decline of any sort.

This has been described in the Wall Street Journal on many occasions, and it's discussed in several retirement planning books. While everyone is unique, you need to be aware of the statistics.

Your ability to make complex financial decisions wanes as you age. To think otherwise is just magical thinking. The steps you can take that would help depend on your social set-up to some extent.

You're going to want to include someone to look over your shoulder. It can be a trusted family member, a friend, or at some point, an entity like Vanguard (they will definitely manage your finances for a small fee).

You're going to want to simplify your finances. If you have 10 CDs at 10 separate banks, stop it. If you have multiple accounts at Schwab, Fidelity, Vanguard, and TD Ameritrade, consolidate.

You need to have your passwords available for the people who you'd want looking after your finances if you can't.

Whoever you name as your financial POA, you need to sit down and chat with him/her. I can't tell you the number of times I've found out that I've been named a POA and the person hasn't even discussed it with me.
+1 you have the ability now to consolidate and simplify Imagine who will take over your finances and portfolio when you can no longer make good financial decisions? Write everything out, have a good plan. And hope for the best!
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Re: Bogleheads: What are you doing to prepare for dementia/alzheimers?

Post by bayview » Fri Feb 23, 2018 9:35 pm

I would note that if one is purchasing LTC insurance or considering a continuing care community, one would not want to have a dementia diagnosis already present on one’s outpatient (or inpatient) records.

Certainly, if one is concerned about cognitive issues that have not yet been officially diagnosed, one should act immediately to best deal with investments and any other financial issues.

Side note: Lewy Body Dementia = Parkinson’s Syndrome/ Disease + dementia.
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Re: Bogleheads: What are you doing to prepare for dementia/alzheimers?

Post by cheese_breath » Fri Feb 23, 2018 9:45 pm

I forget.
The surest way to know the future is when it becomes the past.

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Re: Bogleheads: What are you doing to prepare for dementia/alzheimers?

Post by DrGoogle2017 » Fri Feb 23, 2018 9:58 pm

Skiffy wrote:
Fri Feb 23, 2018 6:50 pm
The trouble with developing dementia is you may not be self aware of decline and inability to make good decisions. MIL had to be removed (unwillingly) from her home, she forgot to eat, drink, bills unpaid etc. She still thinks she could live by herself, was diagnosed with dementia about a year ago. She is not aware of her own decline or her rapidly deteriorating memory.

What can you do if you don’t have someone who is willing to intervene, even against your will !
Why would this be a problem if you are single? Is it better to die a bit early or to prolong a life with dementia. Both of my parents refused aggressive treatment to hopefully prolong their lives. My mom refused chemotherapy, she said she was old and only accepted radiation therapy, which was less drastic treatment to her. I’m not sure chemotherapy wouldnt have prolonged her life as much. But she did live a lot longer than most people with her type of cancer.
My dad refused kidney surgery, I think in the end he had dialysis three times a week, and did die of old age.

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Re: Bogleheads: What are you doing to prepare for dementia/alzheimers?

Post by pondering » Fri Feb 23, 2018 11:48 pm

About 20% of people in there 80s develop diagnosed dementia.

My Mom clearly got hit in her late 60s.

I'm hoping it is a sugar related disorder, and I'll find a way to eliminate sugar from my diet.
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Re: Bogleheads: What are you doing to prepare for dementia/alzheimers?

Post by mariezzz » Sat Feb 24, 2018 1:07 am

Aerobic exercise (like brisk walking for 45 minutes 5 x / week). It's the best "pill we have to preserve cognitive function.

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Re: Bogleheads: What are you doing to prepare for dementia/alzheimers?

Post by alpine_boglehead » Sat Feb 24, 2018 1:09 am

There is also this recent thread discussing an interesting article by Larry Swedroe which also included a discussion of this topic - he nominates dementia as one of the the "4 Horsemen of Your Portfolio".

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Re: Bogleheads: What are you doing to prepare for dementia/alzheimers?

Post by littlebird » Sat Feb 24, 2018 1:24 am

DrGoogle2017 wrote:
Fri Feb 23, 2018 9:58 pm

Why would this be a problem if you are single? Is it better to die a bit early or to prolong a life with dementia. Both of my parents refused aggressive treatment to hopefully prolong their lives. My mom refused chemotherapy, she said she was old and only accepted radiation therapy, which was less drastic treatment to her. I’m not sure chemotherapy wouldnt have prolonged her life as much. But she did live a lot longer than most people with her type of cancer.
My dad refused kidney surgery, I think in the end he had dialysis three times a week, and did die of old age.
The problem might not be that you die, but that you live and are a victim of fraud or outright theft, and your last few years are lived in destitution, when they could have at least been comfortable. And no, if you're destitute, you won't get the same care you would have gotten had you still had money and someone to make decisions on your behalf.

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Re: Bogleheads: What are you doing to prepare for dementia/alzheimers?

Post by Gray » Sat Feb 24, 2018 5:12 am

Apply for long term care insurance NOW. Once you see a doctor about symptoms and it’s part of your medical record, you can forget it.

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Re: Bogleheads: What are you doing to prepare for dementia/alzheimers?

Post by afan » Sat Feb 24, 2018 9:09 am

I looked into this on behalf of an elderly individual I was helping. I agree that a corporate trustee may have a role for someone with no appropriate family members or friends who can do these tasks. But this is not a great business for the corporate trust departments.

They make their money by taking a percent of assets and collecting some fees for trading investments and doing extra work like preparing tax returns. Typically they make no money on anything specific to a particular trust beneficiary. Paying bills, making sure that insurance coverage is up correct as the beneficiary's circumstances change, etc. These are critical but they are not revenue streams, so I was worried about how much attention they would get. My conversations with trust officers at a number of banks were not reassuring. They did not want to talk about these services.

Searching online I found one large bank that made much of it's services along these lines, claiming to have elder care expertise. But when I contacted them the trust officers had no idea what I was talking about. I had to email them the link to the extensive web pages the bank had put up. After much back and forth it turned out that the entire service consisted of the bank hiring an outside company, at substantial additional fees, to deliver these promises.

Take away- such companies do exist so someone who needs this kind of help might be able to find it. I have no idea about quality or how to research them. If I we're still looking I would probably start with an elder care attorney and ask for advice.

The bank trustee approach only works for people with a lot of money. Although Vanguard will accept trusts as small as $500,000, most banks will not be remotely interested in trusts below a couple of million. Since your retirement assets would not be in the trust, I don't know whether one could get a bank to manage those funds along with a trust and compute the fees on the total amount of assets even if the trust proper was too small to meet their standards.

I don't think I would put any value on having a local office I could visit in person. There are so many other problems with dealing with corporate trustees that imposing any other restrictions might make it impossible to find one at all.

The elderly person I had been helping had enough money to shop for and buy into a CCRC many years before it was needed. Used it as a pied a terre for years. Would have dinner there and socialize, joined some clubs and so forth, but would go back home at night. Gradually changed from mainly being at home to spending nearly all the time at the CCRC. This approach allowed this person to get the place they most wanted and, being perfectly healthy with plenty of resources, there was no problem with being admitted. Of course this solution only works for those who can afford it.
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Re: Bogleheads: What are you doing to prepare for dementia/alzheimers?

Post by scone » Sat Feb 24, 2018 9:35 am

I am a retired widow, with no living close relatives, and I don't want to burden my friends with my care. So I have a will, trust, POA, medical POA, and Advance Directives. I've hired a professional guardian to make the "pull the plug" decision when I am at the end of life. I've arranged to hire help around the house as I get less able, and I'm thinking of doing a little remodeling to make my home more "elder friendly."

I even bought a cemetery plot, and worked out other details on final arrangements. You'd be surprised at the number of decisions and choices there are, and if you don't make them, someone else will have to.

In the meantime, I'm spending conservatively on the assumption that I might need very expensive nursing home care at some point.

All this may be moot, in that I may die of my cancer, get hit by a bus, fall down the stairs, or what have you. All flesh is as grass. But this preparatory planning makes me feel I've done everything I can, and that gives me some peace of mind.
"My bond allocation is the amount of money that I cannot afford to lose." -- Taylor Larimore

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Re: Bogleheads: What are you doing to prepare for dementia/alzheimers?

Post by CULater » Sat Feb 24, 2018 10:38 am

scone wrote:
Sat Feb 24, 2018 9:35 am
I am a retired widow, with no living close relatives, and I don't want to burden my friends with my care. So I have a will, trust, POA, medical POA, and Advance Directives. I've hired a professional guardian to make the "pull the plug" decision when I am at the end of life. I've arranged to hire help around the house as I get less able, and I'm thinking of doing a little remodeling to make my home more "elder friendly."

I even bought a cemetery plot, and worked out other details on final arrangements. You'd be surprised at the number of decisions and choices there are, and if you don't make them, someone else will have to.

In the meantime, I'm spending conservatively on the assumption that I might need very expensive nursing home care at some point.

All this may be moot, in that I may die of my cancer, get hit by a bus, fall down the stairs, or what have you. All flesh is as grass. But this preparatory planning makes me feel I've done everything I can, and that gives me some peace of mind.
Where do you find and hire a "professional guardian?"
May you have the hindsight to know where you've been, The foresight to know where you're going, And the insight to know when you've gone too far. ~ Irish Blessing

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Re: Bogleheads: What are you doing to prepare for dementia/alzheimers?

Post by dm200 » Sat Feb 24, 2018 10:48 am

The problem might not be that you die, but that you live and are a victim of fraud or outright theft, and your last few years are lived in destitution, when they could have at least been comfortable. And no, if you're destitute, you won't get the same care you would have gotten had you still had money and someone to make decisions on your behalf
.

This is a huge problem and risk for those with some degree of assets.

Family members and friends/acquaintences can often reduce such risks. On the other hand, such folks are commonly the ones who commit such fraud or theft.

From what I have seen as well, the onset of mental impiairmant can come quickly. My uncle (father's older brother - never married) handled my late father's financial records/taxes/etc. for their family farm, etc. for decades - and did a good/fair job. In his later years, thiugh, very quickly, things became a real mess. Fortunately, my brother was able and willing to step in and clean things up.

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Re: Bogleheads: What are you doing to prepare for dementia/alzheimers?

Post by CULater » Sat Feb 24, 2018 11:08 am

dm200 wrote:
Sat Feb 24, 2018 10:48 am
The problem might not be that you die, but that you live and are a victim of fraud or outright theft, and your last few years are lived in destitution, when they could have at least been comfortable. And no, if you're destitute, you won't get the same care you would have gotten had you still had money and someone to make decisions on your behalf
.

This is a huge problem and risk for those with some degree of assets.

Family members and friends/acquaintences can often reduce such risks. On the other hand, such folks are commonly the ones who commit such fraud or theft.

From what I have seen as well, the onset of mental impiairmant can come quickly. My uncle (father's older brother - never married) handled my late father's financial records/taxes/etc. for their family farm, etc. for decades - and did a good/fair job. In his later years, thiugh, very quickly, things became a real mess. Fortunately, my brother was able and willing to step in and clean things up.
Yes, I hadn't considered quick onset until my friend went from normal functioning to his current state in just a few months and is now incapable of managing his own affairs or even taking care of himself. You think of these things as being gradual and that you'll have enough time to prepare, so tend to put it off. This is the part that concerns me.
May you have the hindsight to know where you've been, The foresight to know where you're going, And the insight to know when you've gone too far. ~ Irish Blessing

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Re: Bogleheads: What are you doing to prepare for dementia/alzheimers?

Post by scone » Sat Feb 24, 2018 1:55 pm

CULater wrote:
Sat Feb 24, 2018 10:38 am
scone wrote:
Sat Feb 24, 2018 9:35 am
I am a retired widow, with no living close relatives, and I don't want to burden my friends with my care. So I have a will, trust, POA, medical POA, and Advance Directives. I've hired a professional guardian to make the "pull the plug" decision when I am at the end of life. I've arranged to hire help around the house as I get less able, and I'm thinking of doing a little remodeling to make my home more "elder friendly."

I even bought a cemetery plot, and worked out other details on final arrangements. You'd be surprised at the number of decisions and choices there are, and if you don't make them, someone else will have to.

In the meantime, I'm spending conservatively on the assumption that I might need very expensive nursing home care at some point.

All this may be moot, in that I may die of my cancer, get hit by a bus, fall down the stairs, or what have you. All flesh is as grass. But this preparatory planning makes me feel I've done everything I can, and that gives me some peace of mind.
Where do you find and hire a "professional guardian?"
My minister referred me to her. They are often appointed by the courts to look after people, such as orphans or those with disabilities. Lawyers should have some contacts.
"My bond allocation is the amount of money that I cannot afford to lose." -- Taylor Larimore

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Re: Bogleheads: What are you doing to prepare for dementia/alzheimers?

Post by heyyou » Sat Feb 24, 2018 2:22 pm

What are you doing to prepare for dementia/alzheimers?
With short term memory loss and the kicking while dreaming, I've hired a flat fee advisor (generic S&D portfolio) to be a buffer for my financial affairs. I'm glad that I could retire early, it was the best years of my life. The anti-depressant seems to boost the dreaming but does nothing for my apathy.

Medical tourism for assisted living looks like a good idea, as long as the financial part is controlled from the US. The country of Panama uses US currency as legal tender to avoid the exchange problems seen by their Central American neighbors. Panama only mints a dollar coin called a Balboa. I'm considering medical tourism to the Johns Hopkins hospital there for the expensive brain scan which might put a label on my dementia, but there is no cure. Not too enthusiastic about "Try this pill, let's see if it helps" from the medical/pharma industry here.

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Re: Bogleheads: What are you doing to prepare for dementia/alzheimers?

Post by rosemary11 » Sat Feb 24, 2018 3:00 pm

i agree on the advice "it is prudent not to convert all of one's tax deferred into Roths".
In general, what percentage of tax deferred should be deferred into Roth?

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Re: Bogleheads: What are you doing to prepare for dementia/alzheimers?

Post by mlebuf » Sat Feb 24, 2018 3:22 pm

Read "I'll Have It My Way" by Hattie Bryant. It's an excellent book on preparing for end of life care.

https://www.amazon.com/Ill-Have-My-Way- ... tie+bryant
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Re: Bogleheads: What are you doing to prepare for dementia/alzheimers?

Post by dm200 » Sat Feb 24, 2018 3:29 pm

Again, without getting too deeply into medical matters, as we age, it is more common to be taking multiple prescriptions. Some degree of Mental impairment can be due to either not taking prescriptions properly or side effects and interactions. Get in the habit of using the pill daily containers as well as regularly reviewing drugs with physicians. Tell friends/family about the drugs you take.

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